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Diet, blood pressure and hypertension

Published online by Cambridge University Press:  09 March 2007

Kjeld Hermansen
Kjeld Hermansen*
Affiliation:
Department of Endocrinology and Metabolism, Aarhus Amtssygehus, Aarhus University Hospital, 8000 Aarhus C, Denmark,
*
*Corresponding author: K. Hermansen, fax +45 89 49 7659, email [email protected]
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Abstract

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Prevention of hypertension, and control of blood pressure in patients with hypertension, are necessary for the reduction of cardiovascular morbidity and mortality. Lifestyle modifications are one of the most important tools for effective lowering of blood pressure. Most randomized controlled studies have shown that even a modest weight loss of 3–9 % is associated with a significant reduction in systolic and diastolic blood pressure of roughly 3 mm Hg in overweight people. Limitation of sodium chloride in food has historically been considered the critical change for reducing blood pressure. Changes in sodium intake do affect blood pressure in older persons and in patients with hypertension and diabetes, whereas its role in population blood pressure has proven controversial. Recent meta-analyses indicate that adequate intake of minerals, e.g. potassium and probably calcium, rather than restriction of sodium, should be the focus of dietary recommendations. Although epidemiological data point to a direct relation between the intake of saturated fat, starch and alcohol, as well as an inverse relationship to the intake of omega-3 fatty acids and protein, our knowledge about macronutrients and blood pressure is scanty. It may well prove more productive to look at food instead of placing emphasis on single nutrients. Thus the Dietary Approaches to Stop Hypertension (DASH) demonstrates that a diet rich in fruits, vegetables, low-fat dairy products, fibre and minerals (calcium, potassium and magnesium) produces a potent antihypertensive effect. Such a diet is not very restrictive and should not produce compliance problems. Further high-quality research on the influence of macronutrients and food will yield data for updated recommendations, enabling better prevention and control of the blood pressure problem.

Keywords

Blood pressureHypertensionDiabetesObesityDietWeight reductionMineralsFatCarbohydrateProteinAlcohol
Type
Research Article
Information
British Journal of Nutrition , Volume 83 , Issue S1 , June 2000 , pp. S113 - S119
Copyright
Copyright © The Nutrition Society 2000

References

Ahrens, RA (1975) Sweeteners, Issues and Uncertainties. Washington, D.C.: National Academy of Sciences.Google Scholar
Alderman, MH, Madhavan, S, Cohen, H, Sealey, JE & Laragh, JH (1995) Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension 25, 1144–1152.CrossRefGoogle ScholarPubMed
Allender, PS, Cutler, JA, Follmann, D, Cappuccio, FP, Pryer, J & Elliott, P (1996) Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Annals of Internal Medicine 124, 825–831.CrossRefGoogle ScholarPubMed
Anderson, JW (1983) Plant fiber and blood pressure. Annals of Internal Medicine 98, 842–846.CrossRefGoogle ScholarPubMed
Anon. (1997), –. Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Archives of Internal Medicine 157, 2413–2446.CrossRefGoogle Scholar
Appel, JL, Moore, TJ, Obarzanek, E, Vollmer, WM, Svetkey, LP, Sacks, FM, Bray, GA, Vogt, TM, Cutler, JA, Windhauser, MM, Lin, P-H & Karanja, N (1997) A clinical trial of the effects of dietary patterns on the blood pressure. New England Journal of Medicine 336, 1117–1124.CrossRefGoogle Scholar
Brand, MB,Mulrow, CD, Chiquette, E,Angel, L, Cornell, J,Summerbell, C, Anagnostelis, B & Grimm R, Jr (2000) Dieting to reduce body weight for controlling hypertension in adults. The Cochrane Library, Issue 1. www.update-software.com/abstracts/ab000484.htmGoogle Scholar
Bucher, H, Cook, RJ, Guyatt, GH, Lang, JD, Cokk, DJ, Hatala, R & Hunt, DL (1996) Effects of dietary calcium supplementation on blood pressure: a meta-analysis of randomized controlled trials. Journal of the American Medical Association 275, 1016–1022.CrossRefGoogle ScholarPubMed
Burt, VL, Cutler, JA, Higgins, M, Horan, MJ, Labarthe, D, Whelton, P, Brown, C & Rocella, EJ (1996) Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension 26, 60–69.CrossRefGoogle Scholar
Cappuccio, FP & MacGregor, GA (1991) Does potassium supplementation lower blood pressure? A meta-analysis of published trials. Journal of Hypertension 9, 465–473.CrossRefGoogle ScholarPubMed
Cutler, JA, Follmann, D & Allender, PS (1997) Randomized trials of sodium reduction: an overview. American Journals of Clinical Nutrition 65, (Suppl.), 643S-651S.CrossRefGoogle ScholarPubMed
Graudal, NA, Galløe, AM & Garred, P (1998) Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride. a meta-analysis. Journal of the American Medical Association 279, 1383–1391.CrossRefGoogle ScholarPubMed
Guidelines Subcommittee (1999) The 1999 World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension. Journal of Hypertension 17, 151–183.Google Scholar
Haddy, FJ (1988) Ionic control of vascular smooth muscle cells. Kidney International Supplementum 25, S2-S8.Google ScholarPubMed
Haddy, FJ & Overbeck, HW (1976) The role of humoral agents in volume expanded hypertension. Life Sciences 19, 935–947.CrossRefGoogle ScholarPubMed
Intersalt Cooperative Research Group (1988), –. Intersalt: an International Study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. British Medical Journal 297, 319–328.CrossRefGoogle Scholar
Israel, KD, Michaelis, OE, Reiser, S & Keeney, M (1983) Serum uric acid, inorganic phosphorus, and glutamic–oxalacetic transaminase and blood pressure in carbohydrate-sensitive adults consuming three different levels of sucrose. Annals of Nutrition and Metabolism 27, 425–435.CrossRefGoogle ScholarPubMed
Langford, HG (1983) Dietary potassium and hypertension: epidemiological data. Annals of Internal Medicine 98, 770–772.CrossRefGoogle Scholar
Law, MR (1997) Epidemiologic evidence on salt and blood pressure. American Journal of Hypertension 10, 42S-45S.CrossRefGoogle ScholarPubMed
Margetts, BM, Beilin, LJ, Armstrong, BK & Vandongen, R (1985) A randomized control trial of vegetarian diet in the treatment of mild hypertension. Clinical and Eperimental Pharmacology and Physiology 12, 263–266.CrossRefGoogle ScholarPubMed
Marmot, MG, Elliott, P, Shipley, MJ, Dyer, AR, Ueshima, H, Beevers, DG, Stamler, R, Kesteloot, H, Rose, G & Stamler, J (1994) Alcohol and blood pressure: the INTERSALT study. British Medical Journal 308, 1263–1267.CrossRefGoogle ScholarPubMed
McCarron, DA (1998) Diet and blood pressure — the paradigm shift. Science 281, 933–934.CrossRefGoogle ScholarPubMed
Midgley, PJ, Matthew, AG, Greenwood, CMT & Logan, AG (1996) Effects of reduced dietary sodium on blood pressure. A meta-analysis of randomized controlled trials. Journal of the American Medical Association 275, 1590–1597.CrossRefGoogle ScholarPubMed
Morris, MC (1994) Dietary fats and blood pressure. Journal of Cardiovascular Risk 1, 21–30.CrossRefGoogle ScholarPubMed
Morris, MC, Sacks, FM & Rossner, B (1993) Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation 88, 523–533.CrossRefGoogle ScholarPubMed
Nielsen, S, Hermansen, K, Rasmussen, OW, Thomsen, C & Mogensen, CE (1995) Urinary albumin excretion rate and 24-h ambulatory blood pressure in NIDDM with microalbuminuria: effects of a monounsaturated-enriched diet. Diabetologia 38, 1069–1075.CrossRefGoogle ScholarPubMed
Pauletto, P, Puato, M, Caroli, MG, Casiglia, A, Munhambo, AE, Cazzolato, G, Bittolo, BG, Angeli, MT, Galli, C & Pessina, AC (1996) Blood pressure and atherogenic lipoprotein profiles of fish-diet and vegetarian villagers in Tanzania: the Lugalawa study. Lancet 348, 784–788.CrossRefGoogle ScholarPubMed
Peacock, JM, Folsom, AR, Arnett, DK, Eckfeldt, JH & Szklo, M (1999) Relationship of serum and dietary magnesium to incident hypertension: the Atherosclerosis Risk in Communities (ARIC) Study. Annals of Epidemiology 9, 159–165.CrossRefGoogle ScholarPubMed
Prescott, SL, Jenner, DA, Beilin, B, Margetts, BM & Vandongen, R (1987) Controlled study of the effects of dietary protein on blood pressure in normotensive humans. Clinical and Experimental Pharmacology and Physiology 14, 159–162.CrossRefGoogle ScholarPubMed
Puddey, IB, Beilin, LJ & Vandongen, R (1987) Regular alcohol use raises blood pressure in treated hypertensive subjects. A randomised controlled trial. Lancet i, 647–651.CrossRefGoogle Scholar
Rasmussen, OW, Thomsen, C, Hansen, KW, Vesterlund, M, Winther, E & Hermansen, K (1993) Effects on blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects. Diabetes Care 16, 1565–1571.CrossRefGoogle ScholarPubMed
Rouse, IL, Beilin, LJ, Armstrong, BK & Vandongen, R (1983) Blood pressure lowering effect of vegetarian diet on controlled trial in normotensive subjects. Lancet i, 5–9.CrossRefGoogle Scholar
Ruitz-Gutierrez, V, Muriana, FJ, Guerrero, A, Cert, AM & Villar, J (1996) Plasma lipids, erythrocyte membrane lipids and blood pressure of hypertensive women after ingestion of dietary oleic acid from two different sources. Journal of Hypertension 14, 1483–1490.CrossRefGoogle Scholar
Sacks, FM & Kass, EH (1988) Low blood pressure in vegetarians: effects of specific foods and nutrients. American Journal of Clinical Nutrition 48, (Suppl.), 795–800.CrossRefGoogle ScholarPubMed
Sacks, FM, Obarzanek, E, Windhauser, MM, Svetkey, LP, Vollmer, WM, McCullough, M, Karanja, N, Lin, P-H, Steele, P, Proschan, MA, Evans, MA, Appel, LJ, Bray, GA, Vogt, TM & Moore, TJ (1995) Rationale and design of the Dietary Approaches to Stop Hypertension Trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Annals of Epidemiology 5, 108–118.CrossRefGoogle Scholar
Staessen, J, Fagard, R & Amery, A (1988) The relationship between body weight and blood pressure. Journal of Human Hypertension 2, 207–217.Google ScholarPubMed
Stamler, J (1997) The INTERSALT Study: background, methods, findings, and implications. American Journal of Clinical Nutrition 65, (Suppl.), 626S-642S.CrossRefGoogle Scholar
Stamler, R, Stamler, J, Riedlinger, WF, Algera, G & Roberts, RH (1978) Weight and blood pressure. Findings in hypertension screening of 1 million Americans. Journal of the American Medical Association 240, 1607–1610.CrossRefGoogle ScholarPubMed
Stamler, J, Caggiula, A, Grandits, GA, Kjelsberg, M & Cutler, JA (1996) Relationship to blood pressure of combinations of dietary macronutrients. Findings of the Multiple Risk Factor Intervention Trial (MRFIT). Circulation 94, 2417–2423.CrossRefGoogle ScholarPubMed
Stamler, J, Elliott, P, Kesteloot, H, Nichols, R, Claeys, G, Dyer, AR & Stamler, R (1996) Inverse relation of dietary protein markers with blood pressure. Findings for 10 020 men and women in the INTERSALT study. INTERSALT Cooperative Research Group: INTERnational study of SALT and blood pressure. Circulation 94, 1629–1634.CrossRefGoogle Scholar
Stamler, J, Caggiula, AW & Grandits, GA (1997) Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. American Journal of Clinical Nutrition 65, (Suppl.), 338S-365S.CrossRefGoogle ScholarPubMed
Stevens, VJ, Corrigan, SA, Obarzanek, E, Bernauer, E, Cook, NR, Herbert, P, Mattfeldt-Beman, M, Oberman, A, Sugars, C & Dalcin, AT (1993) Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOPH Collaborative Research Group. Archives of Internal Medicine 153, 849–858.CrossRefGoogle Scholar
Storm, H, Thomsen, C, Pedersen, E, Rasmussen, O, Christiansen, C & Hermansen, K (1997) Comparison of a carbohydrate-rich diet and diets rich in stearic or palmitic acid in NIDDM patients. Effects on lipids, glycemic control, and diurnal blood pressure. Diabetes Care 20, 1807–1813.CrossRefGoogle ScholarPubMed
Svetkey, LP, Simone-Morton, D, Vollmer, WM, Appel, JL, Conlin, PR, Ryan, DH, Ard, J & Kennedy, BM (1999) Effects of dietary patterns on blood pressure. Subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Archives of Internal Medicine 159, 285–293.CrossRefGoogle ScholarPubMed
Taubes, G (1998) The (Political) Science of Salt. Science 281, 898–907.CrossRefGoogle ScholarPubMed
Thomsen, C, Rasmussen, OW, Hansen, KW, Vesterlund, M & Hermansen, K (1995) Comparison of the effects on the diurnal blood pressure, glucose, and lipid levels of a diet rich in monounsaturated fatty acids with a diet rich in polyunsaturated fatty acids in type 2 diabetic subjects. Diabetic Medicine 12, 600–606.CrossRefGoogle Scholar
Trials of Hypertension Prevention Collaborative Research Group (1997) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high–normal blood pressure. Archives of Internal Medicine 157, 657–667.CrossRefGoogle Scholar
Ward, R (1990) Familial aggregation and genetic epidemiology of blood pressure. In Hypertension, Pathophysiology, Diagnosis and Management, pp. 81–100 [JH, Laragh, BM, Brenner, editors]. New York, NY: Raven Press.Google Scholar
Whelton, PK, Buring, J, Borhani, NO, Cohen, JD, Cook, N, Cutler, JA, Kiley, JE, Kuller, LH, Satterfield, S & Sacks, FM (1995) The effect of potassium supplementation in persons with a high–normal blood pressure. Results from Phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOHP) Collaborative Research Group. Annals of Epidemiology 5, 85–95.CrossRefGoogle ScholarPubMed
Whelton, PK, He, J, Cutler, JA, Brancanti, FL, Appel, LJ, Follmann, D & Klag, MJ (1997) Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. Journal of the American Medical Association 297, 1624–1632.CrossRefGoogle Scholar
Whelton, PK, Appel, Jl, Espeland, MA, Applegate, WB, Ettinger, WH, Kostis, JB, Kumanyika, S, Lacy, CR, Johnson, KC, Folmar, S & Cutler, JA (1998) Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacological interventions in the elderly (TONE). Journal of the American Medical Association 279, 839–846.CrossRefGoogle Scholar